Abstract

Objectives: The aim of this study is to evaluate the predictive power of postoperative computed CT aortic volumetric measurements for the occurrence of aortic complications after Type A aortic dissection.

Methods: This was a retrospective analysis of 165 patients with Type A dissection from the adult cardiac surgery database of a single institution from 2001 to 2015. Patients included in the study underwent ascending aorta replacement with a postoperative follow-up of at least 12 months. CT-based volumetric measurements included total lumen volume (total-L), true lumen volume (TL) and false lumen volume (FL). Mortality, cardiovascular complications were assessed with the generalised structure equation model.

Results: Patients with postoperative aortic complications had a significantly higher FL volume (p=0.022; OR: 1.02) and total-L volume (p=0.050; OR: 1.01) on the first postoperative scan. The odds of having aortic complications was raised by 1% with a 1cm3 increase in total-L volume, and 2% with a 1cm3 increase in FL volume. Furthermore, patients with late complications had lower TL:FL ratio in comparison to the uncomplicated group at the second postoperative scan. The TL:FL ratio in the complicated group was constantly below 1 in both the first scan (0.815 ± 0.238) and the second scan (0.813 ± 0.324). The TL:FL ratio was at 5% level of significance to predict late aortic complications.

Conclusions:Post-operative computed tomography volumetric measurements could be an effective tool to predict postoperative aortic complications in acute Type A dissection patients. In the complicated group, 3 months after operation the total-L volume and FL volume demonstrate significant expansion compared to corresponding volumes in the uncomplicated group. Increase in FL by 1cm3 correlates with 2% increase in risk for subsequent development of aortic complications.Complicated patients' volumetric analysis trends lower TL:FL ratio, associated with ratio less than 1. This group of patients needs to be considered for closer follow up and early intervention to prevent life threatening complications.

26TH ANNUAL MEETING OF THE ASIAN SOCIETY FOR CARDIOVASCULAR AND THORACIC SURGERY